HomeMy WebLinkAboutHomestead_Douglas�, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
/ 51ate Fwm Sd73 (R614-03)
Prescribed by the Department ol Local Govemment Finance
FORM YEAR
HC70 �
INSTRUCTIONS: See revcrsc side !or /iling inslruclions �'� �J � }� .
'LI �� �
��S'f.i�`i'��.�'`-'��:.^���°i�*',��1'£k'-`�'�'�.`���tkc.r;>�l�,�.-"3'` °'�tCERTI CAiION STAiEMENT.-r"s'='.�'S��.sX"�l>h`+'��������7t`,'S�-s`« rw�� �':.���=�
� M�e) certify lh�6ri•the 1`st d�S�arch. 20_
I(We) occupied as our dpal place oi residence ih ollowing described real property for which a Homestead Property Tac Credit is here� y daimed:
�(VJe) owned ❑ fve buying under wntract •�
Have a beneficial interest in ihe entity ihat is liable (or the property taxes on the property and fhat owns the property or is buying under a wnVaU.
If buying on conUad, Fee Simple ownefs name
County
H any
of the
conVacl is reoorded
Tamship
Is the
Record number
township)
Page
property ❑ MoEile Homo (LC. biJ-�
sWCNre or Me land not exceeding one (7) a ihat immediatey wrtounds that sWCtura is usetl b produca income. desaibe fhe use and pwtbn
Ka irwome. • � 7aCJ
`'.-'�"r-,�?�'t�'=�?-��SU�xatsa���T3t`�u^s-`.��a STANDARD'.DEDUCTION'ALCOWANCEtr�-�'�j.��''��,'"'v�,�`�u-".�,"s-'`�""i`ear"`� �f;���,s.,"�'ar.'�:
20 _ Pay 20 _
Lesser M 1/2 Homestead
Vauanon or E35.000
5
Sgnawre of Auditw ' Date sgnetl
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1126
STARf00.A1!)H�R:/NN1
A�YR(T'Ef1 BY t�\R NNROfK M��II. Ti.!nn
PIF�t[R�BmBY
IAFASIIIfR WR�I TU
IndiviJuaL. anJ ma;riN coupl<. are luni�ed ia ore honre�ead �andaN deduciinn. As �he �eceip� of ihis deductan Ixcomes
more beneficial. there is morc incentne ihv� r�er (or hamnttad fnud. HomcaeaJ Baud causes hi�her �a� bills (or all: thertfore.
HEA IiJi-?I709 «quim uxpa�ers v.ho receire �he hanes�caJ standud de�iunion m.erilv ihai t6ey art eli;ide w rettnc �he
benefit am1 tu p�m'ide aiklitio�ul iJrntityinc infurtnatiun Mee.'vey ro allw' counn' gaemmrnt tu barcr moniror homrsrcad
filin�. This inl'nrma�ion x�ill M Aept trnfidential and can nnly h: acae>�ed M1y aWhorieeJ munry o(ficials. The Uepanmrm of
I.ucal Gm'<rnnem Fi`uMe will ux �hfs fnformation tu create [rois ihat will help awna� offiriaL. eliminarc homestcaJ Fraud.
.•, ,, ,
Taxnaver Name Pruoertr Address
Douglas, Cheryl
Cheryl Douglas
430 S Seminary
PRINCETON IN 47670-2432
��������ii�i��ii�iii���nni�i�i�ii�ii������������i��nni�i��
130 S Seminarv
Princeton IN;7670
State Parcel Number Lesal Descriotion
Y 26-12-07-403-000.977-028 019�00977-DO PT SE 7-2-10 .17 AC
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
�herU I I �tn f'1
g Address (numbcr and strcct, city, smre, snd ZIP code)
r30 S S�T'7 .a�r PV` i nC2
Security Yumbef (lazi 5 dieits) Drivas Lic<R�e/Suie ID I.iunber (laz� 5 digits)
��°
'-1 n�-hon u I wa
e.4ddress (Number and st ttL cii}', state, and ZIP caie)
( 30 r� c�
Sccurity Numbcr (lazt 5 digiu) Drivcr's Licca�/Statc ID Niun
� �
�o-u. -o,�'�'U��
as Pmperty
- J L{ % LP % �
n � �o�r E-�i
� $ame u pmpeny add�.,
Each undersiened certifies, under penalry o( perjury, that the above and foregoing in(urtnaiiun is trve and correct and that he or she is elicible to
receive the homes�ead standard deduction on this property. Each undersigned al>o understands that, by claiming additional homestead deductior
unlawfully, he or she may be liable for back �aees and substannal financial penalties.
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